Iris Clinic, Internal Medicine Clinic.

Suddenly, a large crowd rushes in, and Rachel and Jenard are startled.

Behind those people, Kim Hee-jin followed closely behind, shrugging apologetically at the two doctors in the consultation room to apologize. Because, she couldn't stop it just now.

"What's wrong? Dear Rubio...... A. Dr. Jenard asked.

Because, the other party has a large family, and there are eight people, including Mr. and Mrs. Rubio, Rubio's grandparents, two Rubio children, and the child's grandparents.

The day before yesterday, Mrs. Rubio had a regular medical check-up at Dr. Yenade's, who had received the report in the morning, but had not yet had time to see it. Because these days are too busy.

Jenard believes that Mrs. Rubio has always been in good health and energetic, and the previous physical examinations have been quite normal, and this time there should be no major problems.

So, instead of rushing to see Mrs. Rubio's, Dr. Jenard read the reports of several other clients first.

"Doctor Jenard, I'm going to be finished, I'm going to collapse, you save me!" Mrs. Rubio looked depressed, her eyes were red and slightly swollen, and there were tears on her face, apparently she had cried not long ago.

"Don't worry, sit down and talk slowly." Jenard was also panicked, not knowing what was happening, and hurriedly asked the other party to sit down.

Then, Kim really wanted to invite the rest of the Rubio family to sit outside, because the room was too crowded, but they all shook their heads.

Kim Hee really wanted to hear about the situation here, so she didn't force it and stayed.

"I guess I have a tumor, I don't know if it's early or late, if it's advanced, it's really ......," said Mrs. Rubio with a sad face.

If it's late, then the sky is really going to fall.

Although many types of cancer have become "chronic" in the United States and the mortality rate is not so high, there are also many tumors, especially in the middle and advanced stages, that can kill people. The kind with a very low survival rate.

Even "chronic disease" type of cancer is quite troublesome, and the quality of life in the future is definitely the same as before the disease.

"Wait a minute, I'll look at the report. I'm sorry, Mrs. Rubio, I've been too busy these days to see you. I think you've always been in great health...... Dr. Jenard explained, and then, before she could bring up the electronic version of Mrs. Rubio's report, Mrs. Rubio took the initiative to hand it over.

Dr. Jenard took it and looked at it, and was also shocked, indeed...... Something is wrong.

During the physical examination, the other party screened for some cancer indicators. Because in the United States, early cancer screening is more common.

Early detection and early treatment.

The report showed that Mrs. Rubio had two abnormalities in those indicators, one was an increase in carcinocarbohydrate antigen 125 to 50 U/mL (normal should normally be < 35 U/mL) and an increase in carcinoembryonic antigen (CEA) to 16 ng/mL (normal should normally<5ng/mL）。

Such an important indicator suddenly exceeded, and it is no wonder that the other party and his family immediately came over to consult.

The moment Mrs. Rubio got the report in the morning, she almost broke down, and then quickly called her husband, who then informed his parents, as well as his wife's parents, and everyone was in a hurry.

I didn't care about making an appointment, but it was close anyway, so I simply killed the whole family.

"Rachel, what do you think?" Dr. Jenard wasn't sure for a moment, so he asked Rachel.

Rachel said: "This needs to be carefully investigated. ”

"Is Dr. Chow here? Can you please see Dr. Chow for us? Mr. Rubio said.

It's not that they can't trust Rachel and Jenard, but that such a matter is too urgent and important, and since they are here, they simply go directly to the best doctor here.

Dr. Zhou is a top performer in North America, and his advice is very important and convincing.

"Dr. Zhou is here, let's go, I'll take you to his office."

While he was talking, Zhou Qiao appeared at the door.

Not only him, but several other doctors who had time to go over to see what was going on.

Suddenly, a large group rushed in, and the whole clinic was alarmed. There was also a black girl from the laundry next door at the door.

However, the black girls saw that they were not here to make trouble, but only to consult, so they all retreated.

Rubio's family is also a regular customer of the clinic and residents of the nearby community. The kind of good people.

"Doctor Zhou, that's ......" Jenard briefly explained what had happened, and then handed the paper report in his hand to Zhou Qiao.

Everyone else was watching Zhou Qiao closely, especially the Rubio family, quite nervously.

Who knows, Zhou Qiao flipped through the report casually, and said with a smile: "It's okay, it's not a big problem." ”

"Huh?" Rubio's family was stunned, and said in their hearts, Dr. Zhou should not be a misdiagnosis, right? If this drags on severely, it will be a big deal.

Other diseases can be delayed, but this cancer can't be delayed.

Zhou Qiao explained with a smile: "In fact, in clinical practice, tumor markers are only a monitoring indicator, which does not mean that they are equated with tumors. In addition to tumors, there are many other diseases that can cause these indicators to be exceeded. ”

"For example, carcinocarbosaccharide antigen 125 may be related to uterine fibroids or some gynecological diseases, while carcinoembryonic antigen CEA may be related to intestinal polyps or inflammation."

"Of course, the follow-up investigation must be carried out, but you don't have to be so nervous, you can take it easy."

"Come on, Kim Hee Jin, help everyone brew coffee and black tea, and a few donuts."

Under Zhou Qiao's comfort and invitation, Rubio's family walked out and came to the rest area, finally breathing a sigh of relief.

Although there is still a possibility of a tumor, it seems that the possibility is relatively small when looking at Dr. Zhou's lively conversation.

And they also came back to their senses at this time, taking 10,000 steps back, even if it was a tumor, it was not detected in the previous physical examinations, and this time it was found out, so how should it be early, right?

In the end, Zhou Qiao personally arranged a series of investigations for Mrs. Rubio for these two indicators.

The results came out, and sure enough, there were no major problems, except for relatively small uterine fibroids, as well as intestinal inflammation.

Zhou Qiao was right.

Since Mrs. Rubio does not have any obvious symptoms for the time being, the uterine fibroids are not treated for the time being, but it is recommended to have a fibroid examination every 3 to 6 months, and if the fibroids are found to be enlarged, or if symptoms appear, treatment is considered, which can be treated with medication or surgery.

As for intestinal inflammation, after taking medicine for a week, it should disappear.

Sure enough, a week later, the carcinoembryonic antigen (CEA) was already within the normal range. It's just that carcinogenic carbohydrate antigen 125 is still high, which is also normal, because this indicator is caused by uterine fibroids.

As long as the uterine fibroids are present, this indicator will be exceeded. Unless surgically removed. But fibroids are now smaller and less frequent, so there's no need for that.

"Thank you, Dr. Chow. This time it really scared us to death. Mrs. Rubio patted her chest, glad. She was finally able to return to her normal life and work.

……

The third "Crescent Cup" Young Doctor Minimally Invasive Cardiac Surgery Formula Competition in the United States has begun.

This event was rumored to be held every four years, but after the first competition, everyone found that the effect far exceeded expectations, especially in terms of economy, and the sponsors made a lot of money, so at the strong request of the sponsors, it was changed to once a year.

In fact, it's also a valuable networking opportunity for doctors. If you receive the honor, it will be of great significance to your future career.

So, everyone is quite positive.

Since it is a formula competition, as before, the rules remain the same, and there are still six types of techniques and three forms.

The six types of surgery refer to the competition, which are three types of small incisions: small right thoracic incision or thoracoscopic heart surgery, transleft thoracic small incision or thoracoscopic heart surgery, small incision of the upper sternal heart surgery, and three types of cardiac interventional surgery: mitral valve clamping (MitraClip), Watchman left atrial appendage closure and transcatheter aortic valve replacement (TAVR or TAVI).

The three formats are the way of competition, which are simulated confrontation, surgical video and live broadcast.

This time, not only Zhou Qiao served as a judge for the National Finals, but in the California division, Zhou Qiao, Murphy, and Stephanie all became judges.

Although the judges in the sub-divisions are not as valuable as the National Finals, it is also a rare honor.

When the news broke, many doctors in California were talking about it.

"Wow, Dr. Zhou, they're actually judges."

"Yes, Iris Clinic, there are three judges in the sub-division at once, and Dr. Zhou is still the judge of the finals, sitting with those top academicians, oh my God, I can't imagine it."

"This, you say, will Dr. Zhou put some water on me?"

"Then you have to make it to the finals!"

"Forget it, I'll just talk about it casually." The doctor was very happy because he participated in the competition for two consecutive years, and it was a participation award.

"This time, I won't sign up, I'll leave the opportunity to someone else."

There were many doctors, all of whom gave up this time. Mainly, he was hit by Zhou Qiao.

Two years ago, although Dr. Zhou was powerful, everyone was in the same "camp", all in the contestant area, and now? Dr. Chow has gone beyond himself and is a judge.

How else does this make everyone participate? Especially, some older ones are more face-saving.

I usually call Dr. Zhou a brother and a brother, but now I call others "teacher"? No, no, no, not anymore. Opportunity for young people to go.

Because of Zhou Qiao's variable, the organizing committee found that in this competition, almost all the contestants were junior doctors.

That's a good thing, too. Young doctors, naturally, the younger the better.

Zhou Qiao, Murphy and Stephanie have all received many surgical videos from the contestants in the past few days, watched them together in the conference room, and then scored them.

Of course, each fights its own.

It is relatively rare for three judges to get together to work, because most of the other people, even if they are in the same organization, watch the video alone and score it separately.

On this day, the three of them were watching a video together, and suddenly, a message popped up on Stephanie's computer.

It turned out that a clinic referred a schizophrenic patient, whose condition was a bit complicated, and Stephanie had a lot of knowledge in the field of psychiatry, and she had published a lot of related academic papers, and she was also a well-known psychiatrist in San Francisco.

Subsequently, Stephanie also received a call from the patient's parents to make an appointment for the consultation.

At 10 a.m. on Wednesday, the patient's parents arrived with their children.

This is a high school girl, and the patient's parents are talking about their child's condition, which began about two months ago.

At that time, the patient had several quarrels with his classmates at school, and the boat of friendship capsized, so he was a little depressed.

Then, there is a sleep abnormality, and it is easy to wake up after falling asleep, sometimes hallucinations, and the temper becomes more and more irritable.

The mother felt that the child's state was not right, so she enlightened her, but it was useless, the child not only quarreled with his friends, but also quarreled with his parents at home.

About a month later, the child's mother couldn't stand it anymore and felt that this was not a solution, so she took the girl to a clinic near her home and asked a psychiatrist for counseling.

Doctor diagnosed "schizophrenia"!

The family was stunned and hurriedly cooperated with the treatment.

However, after taking the medicine according to the doctor's instructions for a month, it did not get better, and the child became more and more "chattering".

The psychiatrist there couldn't figure it out, so he suggested coming to Stephanie and referred her.

After Stephanie understood the situation, she first arranged for the other party to check her liver function.

"Doctor, we're here to see a psychiatric disease, what are we going to do to check liver function?" The girl's mother was full of doubts.

Originally, the psychiatrist over there admired Stephanie very much, saying that if she came here, there was a high probability that she would get better soon. However, after coming, the well-known psychiatrist did not immediately carry out psychological counseling, but arranged for liver function to be checked as soon as possible.

What the hell is this?

Seeing that the girl's family was puzzled, Stephanie explained: "You have been taking medicine for so long, but your condition is not improving, most of it is because the medicine is not right." Let's not talk about whether it is schizophrenia or not, just because this medicine is not symptomatic for a month, I suspect that her liver function has been impaired. If this happens, I will first help her to regulate her body and restore her liver function. ”

"Huh?" The girl's family was stunned.

But since Dr. Stephanie was so serious, they had to cooperate.

The results made them dumbfounded, and the report showed that the aminotransferases were super high, and the liver function was really impaired.

Oh, my God!

Mental illness is not cured, and new diseases are added.

"Dr. Stephanie, what now?" The girl's family was in a hurry.

At the same time, I also admire Stephanie even more. The heart says that the well-known psychiatrist is different.

That's because Stephanie is not only a psychiatrist, but also a super surgeon, proficient in many kinds of surgeries, and can be regarded as an all-rounder. Her focus is naturally different from that of ordinary psychiatrists.

"Now stop the previous medication immediately, and then start liver protection treatment." Stephanie admits the girl to a community hospital and asks Nanako Chiba to help restore the girl's liver function.

On the other hand, Stephanie took the course of the disease and went to chat with Zhou Qiao. Because she felt that the girl's condition was a little strange.

The girl was reported to have impaired liver function, but no signs of biliary tract damage.

Hepatobiliary, hepatobiliary, there is a Chinese idiom called "hepatobiliary photo", these two organs, the anatomical position is extremely similar, and the functions are also closely related.

Usually, liver function is impaired, and bile function is more or less affected. Especially the bile ducts.

Stephanie is a medical genius and certainly knows this.

That's what's weird.

Some doctors may ignore such a small problem and think it is normal, but in Stephanie's opinion, it is not normal.

When Zhou Qiao heard this, he was also interested, and called Murphy and Nanako Chiba to discuss the girl's condition.

Blessed is the girl, so many top doctors help her consult.

Subsequently, a series of investigations began.

The results obtained, a lot of "strange" places.

For example, the girl was thin and had a BMI of only 13, but during a liver puncture, it was found that her liver had an infiltrate of fat cells.

At the same time, the girl's liver pathological tissue examination found that she had chronic liver damage, which did not support acute drug-induced liver damage.

Not only that, Iris Tiantuan also found that there was a special protein in her liver tissue that was severely missing, which is generally considered to be a hereditary disease - progressive familial intrahepatic cholestasis type 3, but the results were not supported by subsequent genetic testing.

At this time, the girl had been undergoing liver function repair treatment in the community hospital for more than a week, and to the surprise of Nanako Chiba, the effect was not good.

Because Nanako Chiba is very clever in medicine, it has always been a medicine to cure the disease, and it is impossible to have a bad effect.

Obviously, this is again a contradiction.

The liver is damaged, and liver care treatment is not very effective.

Everyone fell into deep thought for a moment.

Stephanie: "Looking at it this way, her liver function is impaired, and it should be something else, not the drug-induced liver function impairment caused by taking too much medicine as I expected." I'm sorry, I misjudged before. ”

Zhou Qiao waved his hand: "You can't be blamed for this." ”

In fact, even if Stephanie is wrong, it is not harmful to the patient, because the liver function is impaired, and it is beneficial to carry out symptomatic liver function repair treatment.

For example, if there is a shortage of water in the pool, is it wrong to replenish the water in it?

That's right.

But the current situation is that no matter how much you make up for it, you can't make up for it.

What does this mean?

It shows that there is still a leak at the bottom!

(End of chapter)